The author of the review, Sir Robert Francis, led two major inquiries into failures at Mid Staffordshire NHS foundation trust
Photograph: Christopher Furlong/Getty Images

NHS staff who blow the whistle on substandard and dangerous practices are being ignored, bullied or even intimidated in a “climate of fear”, according to an independent review.

A significant proportion of health workers are afraid to blow the whistle about poor patient care and safety failures in the NHS, the government commissioned inquiry, which documented “shocking” accounts of the treatment of whistbleblowers found.

Sir Robert Francis QC, who led two major inquiries into failures at Mid Staffordshire NHS foundation trust, was asked by the health secretary, Jeremy Hunt, to recommend how best staff can be supported to raise concerns after a series hospital scandals suggested staff warnings were quashed.

In an interview with the BBC Radio 4’s Today programme before the launch of the results of his Freedom to Speak Up Review, Francis said: “Some 30% of people who had raised a concern said they felt unsafe after after they had done so. Eighteen per cent of staff said they didn’t trust the system so they wouldn’t speak out; 15% told us they feared being victimised if they did so.

“All that climate of fear is brought about by the experiences of what may be a very few people … I’ve spoken to people who have not only lost their jobs, their livelihood, they’ve not been able to find other jobs to do. And I’m afraid in some cases have felt suicidal and become ill as a result.”

He said he hoped his report would bring a change of culture in the NHS. “Bullying is something I heard a lot about, and it is undoubtedly a problem ... Managers are sometimes so pressurised that they react in ways they wouldn’t do normally. We need to seek to explain why these things happen in the system,” Francis said.

“There will always be concerns that people raise that will affect the reputations or assessments of other people, and the reaction to that can be defensive … What we need are systems which make those kind of conversations normal rather than something that is [seen as] aggressive and threatening.”

In his 200-page report, Francis will reveal how staff who have sounded the alarm about dangerous practices have found themselves shunned, suspended and sacked by hospital bosses instead of having their concerns taken seriously.

It will urge Hunt to push through a series of changes intended to make the NHS become more open when confronted with wrongdoing. Hunt will make a statement in the Commons after prime minister’s questions setting out how the government intends to tackle what is widely regarded as a major problem in the NHS.

His recommendations will lead to an overhaul of trainee doctors’ and nurses’ training to make it “rigorous and enhanced”, which from September will include teaching on how they should alert their superiors if they see unsafe care happening.

Hunt asked the eminent QC to lead the inquiry after meeting six NHS health professionals who had suffered what one of them, Dr David Drew, described as “extreme retaliation after raising concerns about patient care”.

In all, 612 people shared their experiences in the Freedom to Speak Up review, while another 19,764 people completed an online survey detailing their experiences, good and bad, of raising concerns. The vast majority are understood to be overwhelmingly negative.

In his first speech after becoming the new boss of NHS England in April, Simon Stevens praised whistleblowers for helping to reveal cases where NHS care was inadequate. “Of course not every whistleblower will always get it right, but the fact is: patients’ lives are saved when courageous people speak up – openly and honestly – and when each of us takes personal accountability for putting things right.”

In April 2013, two months after Francis’s Mid Staffs report, the Royal College of Nursing voiced its concerns about a “culture of fear and intimidation” in some parts of the NHS.

An ICM survey of 8,262 nurses for the RCM found that 24% of them had been discouraged or warned off going public with concerns about the quality of patient care. Almost half (45%) of participants said their employer took no action about the concerns raised, while 44% said concern about being victimised or suffering reprisals would make them think twice about whether to sound the alarm.

Francis invited contributions from whistleblowers along with those who have been deterred from speaking out, employers, trade unions and professional representative bodies, as well as organisations which supported those who raised concerns.

Francis said at the time of the review being announced in June that the two previous inquiries had shown the “appalling consequences for patients when there is a ‘closed ranks’ culture”. “We need a culture where ‘I need to report this’ is the thought foremost in the mind of any NHS worker that has concerns – a culture where concerns are listened to and acted upon,” he said.

Chris Hopson, chief executive of NHS Providers, the association of NHS foundation trusts and trusts, conceded that “there is a significant minority of trusts where whistleblowers are not being treated appropriately”. “Every single case where that occurs is a case where we need to work very hard to ensure doesn’t happen again.”

But he told the Today programme Francis’s concerns should be put in the context that the NHS had been ranked as the safest health care system in the world.

Hopson pointed out that only 0.06% of NHS interactions with patients ended in complaints and that more that 80% of patients were satisfied with the care they received.